Analyzing the failures of percutaneous closure of the patent ductus arteriosus in patients over 5 kg.

UNLABELLED: Percutaneous closure of the patent ductus is the gold standard therapy. Our aim was to analyze our failures between 2001 and 2010. METHODS: All patients over 5 kg benefited from a transcatheter attempt at duct closure. Coils and Amplatzer duct occluder (ADO) I were used before 2008, and ADO I and ADO II afterward. The failure was recovered when another percutaneous attempt was successful and definite when surgery was needed. RESULTS: There were 138 patients. Coils were used in 22 patients (16%), ADO I in 74 (54%), and ADO II in 42 (30%). Immediate and 6-month closure rates were 55% and 100% for coils, 40% and 96% for the ADO I, and 74% and 93% for the ADO II, respectively. There were no failures in the coil group, and 3 failures in each of the ADO I and ADO II groups. Among the 3 ADO I failures, 1 was recovered after device migration into the abdominal aorta. The 2 other failures were definite, due to immediate device protrusion, once in the aorta and once in the pulmonary artery. One of the 3 ADO II failures was definite, due to protrusion into the aorta, 10 days following the procedure. The two other failures were due to immediate device migration into the pulmonary artery, and were both recovered. CONCLUSIONS: 97% of ducts can be closed percutaneously. The combination of coil and ADO I gives excellent results. Failed attempts with the ADO II were bailed out by the ADO I.

Development of catheter-based treatment of patent ductus arteriosus: a medium-sized centre experience.

BACKGROUND: Despite the availability of effective devices, percutaneous closure of patent ductus arteriosus (PDA) can be challenging in some situations. AIM: To describe our initial experience of percutaneous PDA closure. METHODS: Between 2001 and 2007, 73 consecutive patients aged 3 months to 70 years underwent transcatheter PDA closure. An Amplatzer duct occluder (ADO) was chosen for ducts greater than 2 mm (n=50) and a Detachable coil (DC) for smaller ducts (n=23). RESULTS: The diameter of the ducts ranged from 1 to 7.2 (mean 2.9+/-1.3) mm. The prostheses were implanted successfully in all patients. The complete closure rate reached 98% in the ADO group and 100% in the DC group at 12 months. Four (5.4%) patients showed asymptomatic device protrusion: three patients (5, 6 and 10 kg) into the aortic isthmus and one patient (7 kg) into the pulmonary artery (PA). One patient (7 kg) experienced transient severe bradycardia due to pulmonary air embolism. Another patient (3.3 kg) had a permanent asymptomatic occlusion of the femoral artery. In a third patient (17 kg), the ADO migrated asymptomatically into the descending aorta and was discovered 12 months later. CONCLUSION: Even during the learning curve, percutaneous PDA closure can give excellent results. Strict adherence to protocols and careful follow-up assessments are mandatory. In small infants, the use of the ADO may lead to obstruction in the aorta or PA, or to device migration. Cautious surveillance for untoward events is essential, especially in small infants with large ducts.